The Plague Within (Brier Hospital Series)

by Lawrence Gold

  Jack turned to Mickey. “Let’s give her blood.”

  An hour later, Julie was still at work dissecting and exploring. Rachel’s vital signs remained borderline, and they’d given additional blood, platelets, and plasma expanders.

  Suddenly, Julie froze. “Wait a minute. I feel something near the spleen.”

  Julie was sweating from the physical effort. The circulation nurse blotted her forehead with a green towel as beads of perspiration formed.

  “I need longer arms, Jack. Rotate her ten degrees toward me and get me a three-inch platform so I can get up in the world.”

  Now in a more comfortable position, Julie’s arm had penetrated the incision up to her elbow.

  “Shit!” she yelled as her arm suddenly jerked upward. “I just broke through into something. I hope it’s not the stomach or the diaphragm. Get me a large drainage tube.” A fetid smell rose from the abdominal cavity, permeating the operating room. Julie turned her head away in order to breathe.

  The scrub nurse handed Julie a half-inch diameter clear plastic tube with a large hole at the tip and smaller holes on the sides. Using her right hand as a guide, she passed the tube along her left and into the space she’d inadvertently discovered.

  Julie turned to the circulating nurse. “Attach the tube to suction. Let’s see what we get.”

  The suction machine buzzed and vibrated into action, and immediately upon applying negative pressure to the tube, foul smelling, grey-green pus drained into the suction container. Ten minutes later, they had removed nearly a quart.

  Jack stared at the foul pus. “My God. No wonder she was so sick. Where was it Julie?”

  “It was a subphrenic abscess, a huge pus collection just below Rachel’s left diaphragm.”

  “Are you sure?”

  “No question, Jack. I wish we’d seen it on x-ray or CT scan; maybe we could have drained it without surgery. We have an additional problem; when I broke through, we have to assume contamination of the entire abdominal cavity with infection. I’m going to irrigate the abscess space and the entire abdominal cavity with antibiotics, push a drain through from the abscess to the outside, and leave multiple drains in the abdomen. It’s all pretty traumatic, but I don’t see another choice.”

  Suddenly, the plastic tube filled with bright red blood.

  “Jack,” Mickey shouted, “she’s crashing.”

  “Hang two units of blood. Pump it in as fast as you can. Julie...?”

  Julie looked down into the incision that now welled and pulsated with bright red blood, “Goddamn it, it’s got to be a large artery. Either I ruptured the vessel or the infection so weakened it that it broke on its own.”

  “Keep the blood going, Jack,” she yelled. “So much for my refined small incision,” as she grabbed a large straight surgical scissors and added three inches to the wound.

  “She’s starting to have extra heartbeats,” Mickey said. “I can’t keep her pressure up. Any suggestions, Jack?”

  “Give her more blood; call the blood bank; we’re going to need more units, and set up a Dopamine drip to support her pressure if all else fails.”

  Julie had pulled the small suction tube replacing it with two large bore catheters that could remove more pus. She stuffed the abdomen with surgical towels in an attempt to stem the massive amount of bleeding.

  Mickey peered over the drape. “You must have dampened the bleeding, Julie. Her pressure’s better.”

  “I need a drink, you guys,” Julie said pausing to regain her strength and composure. “Water will do for now, but if we get through this, you owe me.”

  The circulating nurse brought the straw from the ice water bottle to Julie’s lips and she took the opportunity to pull back Julie’s cap and wipe her sweating brow.

  Julie placed a large stainless steel retracting spreader into the incision and cranked it wide open for the largest possible exposure. She carefully removed the blood-soaked towels. As she pulled the third one, the abdomen again welled up with red pulsating blood. Julie reached into the abdominal cavity, felt around for a few moments then yelled, “It’s the splenic artery...I have it!”

  “Great,” Jack said, “what’s next?”

  “There’s no way I’m going to try to repair this artery...it may be infected already. I’m tying it off and removing the spleen.”

  How much more could Rachel tolerate? Jack thought.

  Thirty minutes later, the red-brown spleen lay in the specimen basin. Twenty minutes more, Julie had completed closing her incision and placing her drains.

  Julie examined the spleen. Its main artery had a balloon-like swelling that had ruptured. “It’s a mycotic aneurysm. The vessel wall had thinned due to the infection and then ruptured. It’s a miracle that it hadn’t broken sooner, and if it had ruptured anytime other than here and now, she’d be dead.”

  With an incredible sense of relief, they rolled Rachel into the recovery room.

  Although Rachel’s vital signs and postoperative blood tests remained stable, she failed to achieve consciousness. They transferred her to ICU with the ventilator at her side.

  Chapter Nineteen

  Andre continued his mouse longevity experiments at a fever pitch, as if he’d reached the last few grains of sand in the hourglass of his life. He was driving Raymond Ames, his chief research technician, crazy with demands and complaints.

  Raymond Ames, the eighth child of twelve, was the first in the family to express an interest in college. He’d been a good, but not a great student who, due to a great fastball, had earned a scholarship to Oklahoma State University. While he enjoyed baseball, he discovered a love for education. Unfortunately, rural Oklahoma public education had left him unprepared for the rigors of the university. He worked hard and his grades improved, but his fantasy of medical school evaporated after doing poorly on the MCAT (Medical College Aptitude Test). He’d considered a foreign medical school, but rejected the thought immediately as the costs were prohibitive.

  The Army recruiter promised Ray the world, but delivered Iraq. He hated the thoughtless regimentation of military life but stuck with it when they supported his Masters in Chemistry. He worked in several research laboratories at Walter Reed Army Medical Center where researchers found him reliable and obsessive and detail oriented, perfect for a research lab. When he fulfilled his obligation to the service for his Master’s degree, he resigned.

  Ray met and married Shirley Young, a nurse, at the nearby VA Medical Center where he worked for several years as a chief technician in a kidney research center.

  When the position at the Molecular Research Center in Davis, California became available, he applied, and after a four-hour interview, they offered him the position.

  Ray’s latest confrontation with Andre came Friday afternoon when he demanded a compilation of the week’s work on his desk by 10 a.m., Saturday.

  Ray shook his head. “I’ve already put in an extra six hours this week, Dr. Keller. Last pay period, I worked twelve extra hours and haven’t seen dime one.”

  “Look, Ray, this is important research. Good science doesn’t work a nine to five schedule.”

  “I’ve donated as many hours to this project as I can, Doctor. I have a life outside the laboratory.”

  “I’ll put in for those extra hours and the ones you’ll accumulate this week.”

  “Sorry, Doctor. I’ll see you Monday.”

  “I’m very disappointed in you, Raymond. This is not what I expected when I made you my chief technician. Maybe you’re not the man for the job.”

  Raymond smiled. It was all a bluff, and he knew it.

  He’ll never take the time to train another technician to my level or find one who’d tolerate his bullshit.

  Andre shook his head, and then turned to leave. “I expect the data by no later than noon Monday.”

  “You’ll have it sir. Have a good weekend.”

  Elizabeth Brown spent Saturday morning with Andre. He was still fuming over his run-in with Raymond.
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  “Give him a raise and put him on a salary, Andre, if you expect that kind of work out of him.”

  “I can’t. The university has a rigid employment ladder.”

  “Pay him from your grant or hire an assistant for Ray. If you push him too far, he’s going to bolt.”

  “How was your trip to Reno?”

  “My aunt Alice, you remember, I told you about her, has lupus and she’d been doing terribly. She’s going to need kidney dialysis soon. Do you know much about lupus?”

  Andre smiled with condescension. “Of course, I know everything about lupus. The disease exists in several forms, but in the most severe variety, the body begins to make antibodies against itself. It’s the immune system attacking our cells as if they were foreign invaders like bacteria or viruses. We don’t know why. These antibodies can attack almost any organ, from the skin to the brain.” He paused. “You know, Elizabeth, I’ve been thinking of expanding my research to involve autoimmune diseases like lupus. There’s a fit with several strains of lupus mice where the cells will only divide so often. We call that programmed cell death, and it’s an intrinsic part of the illness. I’d love to see how DNA virus vectors carrying therapeutic gene fragments could affect these mice.”

  “I love when you talk that way,” she said. “If anyone can find an answer to lupus, Andre, it’s you.”

  Andre began working with two types of lupus mice. He set up each group to examine the effects of gene manipulations on the disease itself, the effects on the so called “gatekeeper gene” thought to prevent Lupus, and on the group’s longevity. The addition of these studies to an already busy work schedule transformed his laboratory from frantic to chaotic. He hired two other research assistants, but they’d take time to train. In addition, the laboratory and the animal care facilities had physical limitations.

  Raymond knocked on Andre’s door. “Sir, we need to cut back somewhere. There’s too much going on. We’re making mistakes and missing things.”

  “I’d love to cut back on Dr. Blake’s work, Raymond, but it’s a major part of our research money. Without it, we’d have to close down. Hang on for a while. I’ll find some way.”

  Over the next few months, Andre worked at a fever pitch and caught up on his work which was destroyed by the activists. He continued to wheedle and cajole for more money and extra hands, but a year later Andre’s lab was still in disarray. Their first few generations of experimental animals had yielded remarkable results; life expectancy of lupus mice was up and the disease remained in remission.

  Andre approached Archie Blake again. “I need to rearrange my priorities. I want to cut back on the retrovirus studies and concentrate on my work with DNA vectors and with the lupus mice.”

  Archie shook his head. “Unless you can become totally self-sufficient and raise your own grant money, there’s no way I can pull you off that work. I have my own obligations. None of us works in a vacuum; we’re all accountable to someone.”

  Since his graduate student days, Andre had presented research findings at scientific meetings. Question and answer periods followed the brief presentations. Later, Andre would stand by at the poster sessions where he’d summarized the study’s findings on large white presentation boards placed on display easels. This format was great for one-to-one discussion on the study’s findings.

  Andre had just presented his mouse longevity data at the American Society for Molecular Biology. The exchanges after his presentation had been challenging. As he stood next to his posters, a middle-aged couple approached.

  “We enjoyed your presentation, Dr. Keller. My name is Greg Wincott and this is my wife Amanda.”

  Andre studied their identification badges. “Pleased to meet you. I see you represent People for Alternative Treatment, Inc., I’m not familiar with that company.”

  “It’s our company. We’re a small, but growing, biotech company dedicated to discovering treatments for rare diseases, many genetic in origin. We’ve been focusing on therapeutic approaches via gene therapy. We’re interested in your work. Can you spare us some time? How about lunch tomorrow? You may find we have a mutuality of interests.”

  Andre needed no encouragement and agreed at once to the meeting.

  At lunch the next day, Greg handed Andre a half-inch thick bound folio. “This will describe PAT, our organization, financial support, laboratory facilities, and some of our ongoing research. There’s much more on the research side, but it’s proprietary, I’m sure you understand.”

  After digesting the material, Andre was sold. This was his way out.

  He called Greg. “I read your material, sir, and the possibility of us working together intrigues me.”

  “Why don’t you come down for a visit? You can see our facilities, talk with our investigators about what it’s like to work at PAT, and we can chat in more detail if you’re ready.”

  They agreed on Wednesday morning.

  Andre sat in morning commuter traffic on the 880 Freeway heading for Emeryville. Unfortunately, this was also the approach to the San Francisco Bay Bridge. He rued the fact that he’d made a morning appointment during rush hour. He was already late. He hated being late, and when he exited at Powell Street his stomach churned with acid. He followed Greg’s precise directions to PAT, a gated complex of five, grass surrounded, modern buildings. He gave his name to the security guard who directed him to corporate headquarters.

  Greg’s third floor office had a view to the northwest that included most of the San Francisco skyline and The Golden Gate Bridge.

  Greg rose to greet his guest. “Good to see you again, Dr. Keller.”

  “Please call me Andre. I’m sorry to be late, but I keep forgetting rush hour in the East Bay.”

  “Call me Greg. We love the Emeryville campus, except for the roads—too many cars and not enough pavement. If you’re ready, let me give you the grand tour.”

  They walked through the executive offices and boardroom, then exited into the morning sun. The northwest breeze blowing across the bay carried the distinct briny ocean aroma. They visited the modern laboratories, animal facilities, and research libraries. Networked computer stations with high-speed Internet access were everywhere. When they came to PAT’s largest lab, Greg introduced Andre to Dr. Rebecca Moulton, an acclaimed molecular biologist, and the director of research.

  “I’ll leave you two alone. Rebecca can give you the inside scoop. I’ll see you back in my office for lunch.”

  Andre spent the next three hours with Rebecca. She was frank and outspoken about Greg and PAT and their fundamental mission—research and development of orphan drugs.

  They sat in Rebecca’s office. She smiled at Andre. “Of course we’re way beyond just orphan drug development. This kind of research, like developing a character in fiction, leads you where it wants to go.” She paused. “Give them some results on orphan drugs, and they’ll let you pursue your own interests.”

  Andre rejoined Amanda and Greg for lunch. They ate at a small glass and stainless table before that fantastic view.

  “Well, Andre, what do you think?”

  “You have an incredible facility here, Greg. I’d love to become a part of it if we can agree on terms.” He stood from the table and stretched, and then continued, “Naturally, I’ve done research regarding PAT and you, sir. I expect that you had me checked out as well. I understand why you and Mrs. Wincott became involved in such a difficult endeavor, and I respect that. I’ve been giving considerable thought to the specific genetic problems on chromosome 19 in Blackfan-Diamond anemia...that should pique his interest, and I have some ideas. I’d be pleased to pursue them, but I need to feel certain that PAT will accommodate my many other research interests.”

  “You help us with that problem,” Amanda said, “and you can write your own ticket.”

  They went on in detail to discuss Andre’s financial and research requirements. After three hours, they had nailed down the basis for an agreement. Greg would have his attorneys prepare the employ
ment contract.

  After weeks of haggling over the details, Greg was having second thoughts about Andre. Maybe such interest in detail and control was a characteristic of a personality that made for a good researcher, but Andre had become annoying.

  Finally, they were ready to sign the contract. They met in Greg’s office with Amanda and Rebecca, called in the notary, signed the contract, and shook hands. Andre would shut down his research lab at Davis and come on board in four months.

  Afterward, Amanda turned to Greg. “We’re so lucky to find someone of Andre’s stature and genius to join us. I’m so excited.”

  Beth Byrnes sat with Barbara Cox, the executive director of Planned Parenthood of Northern California. They were sipping coffee in her cubbyhole office and chatting after Beth’s presentation to the clinic staff on the Nobody’s Fool Program. Beth oriented these lectures toward girls in grades five through nine. In lay terms, and sometimes in street language, when appropriate, Beth discussed the changes girls undergo during puberty, and issues surrounding dating, peer pressure, sexually transmitted diseases, AIDS, and pregnancy prevention. Her presentations were warm, humorous, and due to her open accepting nature, she found herself surrounded after each lecture by girls wanting ever more information.

  Beth’s support of Planned Parenthood was not merely philosophical, although she was unalterably committed to a woman’s right to choose, it was also personal. She recalled it, like it was yesterday, that evening at Highland Hospital in Oakland when she was a student nurse...

  After her initial anxiety, Beth found the excitement and the pace of the emergency room intoxicating. It was approaching ten p.m., about an hour left on her shift, when the siren blared on approach, and then the ambulance suddenly screeched to a stop at the ER entrance. Seconds later, the doors slid open and two EMTs pushed a gurney holding a young girl. They were screaming, “She’s coding!”